Drug overdose deaths*

Number of drug poisoning deaths per 100,000 population.

The 2021 County Health Rankings used data from 2017-2019 for this measure.

Reason for Including

Drug overdose deaths are a leading contributor to premature death and are largely preventable.[1] Currently, the United States is experiencing an epidemic of drug overdose deaths. Since 2000, the rate of drug overdose deaths has increased by 137% nationwide. Opioids contribute largely to drug overdose deaths; since 2000, there has been a 200% increase in deaths involving opioids (opioid pain relievers and heroin).[2]

Key Measure Methods

Drug Overdose Deaths is a Rate

Rates measure the number of events (e.g., deaths, births, etc.) in a given time period (generally one or more years) divided by the average number of people at risk during that period. Rates help us compare health data across counties with different population sizes. Drug Overdose Deaths is the number of deaths due to drug poisoning per 100,000 population.

Deaths are Counted in the County of Residence for the Person Who Died, Rather than the County Where the Death Occurred

It is important to note that deaths are counted in the county of residence of the deceased. So, even if a drug overdose death occurred across the state, the death is counted in the home county of the individual who died.

Drug Overdose Death is a Rare Event (statistically speaking)

While Drug Overdose Deaths is an important indicator of the size of prescription and illicit drug use, small numbers of deaths can result in unreliable and suppressed estimates at the county level, even with multiple years of combined data.

Some Data are Suppressed

A missing value is reported for counties with fewer than 10 drug poisoning deaths in the time frame.


The numerator includes deaths from accidental, intentional, and undetermined drug poisoning by and exposure to: 1) nonopioid analgesics, antipyretics and antirheumatics, 2) antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not elsewhere classified, 3) narcotics and psychodysleptics [hallucinogens], not elsewhere classified, 4) other drugs acting on the autonomic nervous system, and 5) other and unspecified drugs, medicaments and biological substances, over a 3-year period. ICD-10 codes used include X40-X44, X60-X64, X85, and Y10-Y14.


The denominator is the aggregate annual population over the 3-year period.

Can This Measure Be Used to Track Progress

This measure can be used to track progress with some caveats. It is important to note that the estimate provided in the County Health Rankings is a 3-year average. However, in most counties, it is relatively simple to obtain single year estimates from the resource included below. Drug Overdose Deaths data can also be further broken down by year, intent, and drug type. These breakdowns could help measure the impact of interventions specific to drug overdose prevention.

Data Source

Years of Data Used


National Center for Health Statistics - Mortality Files

Data on deaths and births were provided by NCHS and drawn from the National Vital Statistics System (NVSS). These data are submitted to the NVSS by the vital registration systems operated in the jurisdictions legally responsible for registering vital events (i.e., births, deaths, marriages, divorces, and fetal deaths). In prior years of the Rankings, Premature Death was calculated by the National Center for Health Statistics, but this year the Mortality-All County (micro-data) file was requested. This allowed us to calculate Premature Death and Life Expectancy ourselves. While most calculations of mortality rates can be downloaded from CDC WONDER, the calculation of Years of Potential Life Lost and Life Expectancy requires raw data files. 

Digging Deeper
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We recommend starting with the CDC WONDER database, which contains information on drug overdose rates by race, ethnicity, age, gender, geography, and more. Rates can be exported as raw or age-adjusted. Small counties might need to combine multiple years of data to see rates, as CDC suppresses any rates when there are fewer than 10 deaths.

In addition, many states support databases of drug-related hospitalizations or emergency department visits. You can find links to these databases in State-Specific Data Sources.


[1]Shiels MS, et al. Premature mortality from all causes and drug poisonings in the USA according to socioeconomic status and rurality: an analysis of death certificate data by county from 2000–15. The Lancet Public Health. 2019; 4(2); e97 - e106.

[2]Centers for Disease Control and Prevention (CDC). Increases in Drug and Opioid Overdose Deaths — United States, 2000–2014. MMWR Morb Mortal Wkly Rep. 2016; 64(50);1378-82.

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